Since gout is almost always a lifelong condition, experts recommend lifestyle changes that may lessen the need for medications.

Studies suggest that losing excess weight can decrease blood levels of uric acid.

One study found that a weight decrease of approximately 17 pounds led to a 17% decrease in uric acid levels.

Alcoholic beverages, especially beer, can increase blood levels of uric acid, the substance that causes gout. Some experts recommend no more than one alcoholic beverage per day for women and 2 or less per day for men.

Anti-inflammatory medications are very effective for treating gout attacks. They provide some pain relief within 2 to 4 hours and significant pain relief within 24 hours.

They are most effective if taken soon after the start of a gout attack.

Indomethacin is the anti-inflammatory that has been used most extensively, although other strong anti-inflammatories also seem to be effective. Conclusive data comparing the effectiveness of different anti-inflammatories is not available.

Anti-inflammatory medications can cause nausea, stomach pain and bleeding ulcers. Large doses can result in kidney problems and fluid retention. The chance of serious side effects due to anti-inflammatories is greatest for elderly patients.They are best taken with milk or food.

There is some evidence to suggest that the newer anti-inflammatory drugs called COX2 inhibitors (Celebrex, others), which are believed to cause fewer side effects, may be effective for treating gout attacks. Unfortunately, the COX2 inhibitors have recently been associated with increased risk of heart problems (Vioxx was recently taken off the market for this reason), so are used only when there is no other alternative.

Uric acid is the substance that causes gout. The higher the blood levels of uric acid, the greater the chance of having a gout attack.

Normal uric acid levels are less than 7 mg/dL in men and less than 6 mg/dL in premenopausal women. The goal of treatment, when using uric acid-lowering drugs, is a level of less than 7 mg/dL.

In one study, lowering uric acid levels to between 4.6 to 6.6 mg/dL reduced gout attacks by 30% (almost a third).

Allopurinol is a "first-line" therapy for lowering blood levels of uric acid. Allopurinol reduces uric acid to normal levels in 85% of people.

The dose is usually increased slowly over a period of 3 to 4 weeks to avoid problems that can be caused by the passage of large concentrations of uric acid thru the kidney into the urine

Approximately 2% of people treated with allopurinol develop a rash; 1 out of a 1000 people taking allopurinol develop a serious skin reaction (exfoliative dermatitis). If this happens, a different medication will need to be substituted.

Probenecid and sulfinpyrazone are considered by many experts to be, along with allopurinol, first-line drugs for treating high blood levels of uric acid (the substance that causes gout).

There is little available scientific data to guide the selection of uric acid-lowering drugs. Therefore, treatment selection is generally based on the preference of the individual physician and on the general medical condition of the individual patient.

Colchicine, taken in small doses, is the most commonly prescribed drug for gout prevention.

In one study, colchicine was totally effective for preventing gout in 82% of patients, satisfactory in 12%, and unsatisfactory in 6%.

There is no data related to the length of time that colchicine should be taken for gout prevention. Some experts recommend taking it for at least a year after blood levels of uric acid, the substance that causes gout, returns to normal levels.

Because long-term use of colchine (weeks to months) can rarely damage the bone marrow and cause anemia/low blood counts, blood tests that measure blood counts should be done every few months when taking this medication.

Anti-inflammatory drugs such as Aleve/naproxen are considered effective for gout prevention. They are not often used for this purpose, since newer and more effective medications are available. Sometimes, anti-inflammatories are added to colchicine if colchicine is not working adequately to prevent gout attacks.

Long-term use of anti-inflammatories commonly cause side effects including stomach pain, ulcers and bleeding. There is no data available comparing the effectiveness of anti-inflammatories and colchicine.

High purine foods contribute modestly to increasing the blood levels of uric acid, the substance that causes gout. Since gout is often a lifelong condition, experts recommend lifestyle changes that may lessen the need for medications, including moderation in the amount of high purine foods in the diet.

High purine foods include: alcoholic beverages, some seafood and shellfish such as anchovies, sardines, herring, mussels, scallops, trout, certain meats, including, bacon, veal, venison, and organ meats like liver.

Foods that contain moderate amounts of purines include: beef, chicken, duck, pork and ham, crab, lobster, oysters, shrimp, asparagus, kidney beans, lentils, lima beans, mushrooms, and spinach.

Until anti-inflammatory medicines became available, colchicine was the main drug used for gout attacks. They are effective at relieving symptoms of gout attacks, (approximately 75 to 80% get relief within 48 hours).

They are most effective if taken soon after the start of a gout attack.

Anti-inflammatories are now more commonly recommended because of their rapid action (they provide relief within 2 to 4 hours versus colchicine which may take up to 18 hours to start working) and because they tend to cause fewer side effects compared to colchicine.

To effectively treat a gout attack, colchicine must be taken in high doses that almost always cause diarrhea. (For gout prevention, on the other hand, colchicine can generally be taken at lower doses).

Colchicine is generally considered safe for short tem use, except for those with kidney or liver disease or for the frail or elderly.

Oxypurinol is a drug in the allopurinol family, that is only available in the United States for individuals who need uric acid-lowering drugs but who cannot take allopurinol because of an allergy to it. It is still pending full approval by the Food and Drug Adminstration (FDA)

Serious side effects are much more common when colchicine is given by an IV.

It has been occasionally used for people with a gout attack who cannot take medications by mouth,

If IV colchicine is used, guidelines about dosing limits and the way that it is administered should be followed strictly because of possible toxic/serious effects on the bone marrow.

Thiazide Diuretics ("water pills") increase blood levels of uric acid, the substance that causes gout.

Some experts suggest that gout has become less common in the United States since fewer people take thiazide diuretics and take other blood pressure medications instead. Be sure your doctor knows about your gout when other medications are being considered.